The majority of the candidate's past research efforts have focused on issues of access to care for children. At the present time, she wishes to devote her energies to exploring access to pediatric subspecialty care for children with chronic conditions. The existing research on this issue is limited, and she foresees a career devoted to a range of issues from defining the problem to developing and evaluating interventions that intend to expand access. A research career award will allow the candidate to devote substantial time to developing this agenda; to obtain further training in survey development and methods, quality of care, risk adjustment and health workforce; and to perform important analyses. While access to primary pediatric care providers has been explored and discussed extensively in the literature, access to pediatric specialists has not been widely investigated and the adequacy of the current supply of pediatric subspecialists has not been established. The small number of pediatric subspecialty providers may lead to a geographic distribution of providers that limits access for a large segment of the pediatric population at risk. One possible solution to this access problem involves the use of alternative providers, such as adult subspecialists and general pediatricians, to provide care to pediatric patients. The extent to which these providers can increase access to care depends not only on their geographic location but also on their willingness and ability to treat children with chronic illnesses. The specific aims of the current research plan are: 1) to depict the practice location of pediatric and adult subspecialists; 2) to explore the relationship between county characteristics and access to pediatric subspecialty care; 3) to ascertain the extent to which adult subspecialists expand access to care for children with rheumatic diseases; 4) to describe the practice patterns of subspecialists, their comfort with treating a variety of pediatric conditions, and the practice, provider, and market characteristics that influence their decisions to treat pediatric patients; and 5) to determine the independent effects of selected training, personal, and practice characteristics on the likelihood that an adult subspecialist treats pediatric patients. In addition, this research plan includes two pilot studies that explore the role of general pediatricians in treating children with rheumatic conditions and that compare care received across physician management types for children with JRA.